Healthcare Provider Details

I. General information

NPI: 1376294900
Provider Name (Legal Business Name): COLUMBUS EYELID PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BUCKLES CT N STE 110
GAHANNA OH
43230-6884
US

IV. Provider business mailing address

4113 CLAIRMONT RD
UPPER ARLINGTON OH
43220-4501
US

V. Phone/Fax

Practice location:
  • Phone: 614-397-2404
  • Fax:
Mailing address:
  • Phone: 614-397-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. COURTNEY KAUH
Title or Position: PROVIDER/OWNER
Credential: M.D.
Phone: 614-397-2404